Healthcare Provider Details

I. General information

NPI: 1326650011
Provider Name (Legal Business Name): PHYSICAL THERAPY CENTER FOR SPORTS AND PERFORMING ARTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2020
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 E BIG BEAVER RD STE 210
TROY MI
48083-2015
US

IV. Provider business mailing address

1034 WHITTIER RD
GROSSE POINTE PARK MI
48230-1461
US

V. Phone/Fax

Practice location:
  • Phone: 313-550-1592
  • Fax: 947-600-7852
Mailing address:
  • Phone: 313-550-1592
  • Fax: 947-600-7852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDRA MARIE PATTERSON TICHY
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: PT
Phone: 313-550-1592